Reimbursement Levels Research Articles

Reimbursement of hormonal contraceptives and the frequency of induced abortion among teenagers in Sweden

BackgroundReduction in costs of hormonal contraceptives is often proposed to reduce rates of induced abortion among young women. This study investigates the relationship between rates of induced abortion and reimbursement of dispensed hormonal contraceptives among young women in Sweden. Comparisons are made with the Nordic countries Finland, Norway and Denmark.MethodsOfficial statistics on induced abortion and numbers of prescribed and dispensed hormonal contraceptives presented as “Defined Daily Dose/thousand women” (DDD/T) aged 15-19 years were compiled and related to levels of reimbursement in all Swedish counties by using public official data. The Swedish numbers of induced abortion were compared to those of Finland, Norway and Denmark. The main outcome measure was rates of induced abortion and DDD/T.ResultsNo correlation was observed between rates of abortion and reimbursement among Swedish counties. Nor was any correlation found between sales of hormonal contraceptives and the rates of abortion. In a Nordic perspective, Finland and Denmark, which have no reimbursement at all, and Norway all have lower rates of induced abortion than Sweden.ConclusionsReimbursement does not seem to be enough in order to reduce rates of induced abortion. Evidently, other factors such as attitudes, education, religion, tradition or cultural differences in each of Swedish counties as well as in the Nordic countries may be of importance. A more innovative approach is needed in order to facilitate safe sex and to protect young women from unwanted pregnancies.

Medical Device Reimbursement Coverage and Pricing Rules in Korea: Current Practice and Issues with Access to Innovation

The development of health funding policy in Korea has followed the country’s rapid economic development, with a comprehensive National Health Insurance (NHI) system in place by 1989. The funding of medical devices has followed this progression, with incorporation into the NHI reimbursement system in 2000 (several years later than pharmaceuticals), but important issues affecting patient access remain. Although the effect of devices on the NHI budget is relatively modest (only about 4%), because of concerns about NHI sustainability, attention has increasingly been paid to their management and funding. Unlike pharmaceuticals, however, it has been quite challenging to develop clear and fair criteria for reimbursement coverage and pricing of medical devices. The two key and longstanding issues around the reimbursement of medical devices in Korea are how to expedite market entry of improved or innovative medical devices at appropriate prices, and how to satisfactorily lower the reimbursement levels of older devices, thereby making headroom for new technologies to be reimbursed. Despite protracted discussions over the last decade, industry and government have been unable to reach full agreement. There has been some progress (e.g., introduction of the Value Appraisal and the Revaluation Systems), but there remains urgent need for productive discussion and consensus between government and industry regarding reasonable funding rules, transparency, and clarity in the reimbursement pricing process for medical devices.

Effects of changes in health insurance reimbursement level on outpatient service utilization of rural diabetics: evidence from Jiangsu Province, China.

BackgroundOutpatient reimbursement levels of the New Rural Cooperative Medical Scheme have changed in recent years in China, and those changes may have a greater impact on patients with chronic diseases due to their higher outpatient expenses. This study represents the first attempt to identify the effects of reimbursement level on outpatient service utilization for chronic patients in rural China and it also gives strong estimation results by conducting a tracer illness study in order to control for possible biases associated with studying several diseases together.MethodsThis study used difference-in-differences models to examine how changes in yearly maximum reimbursement amount and outpatient reimbursement rates affected rural residents with type 2 diabetes in three counties in Jiangsu Province, China. Other factors, such as sex, age and severity of illness, were also included in the model estimations. To make sure the treated group and control group are comparable, Propensity Score Match (PSM) was used to analysis the gender, age and severity of illness of the two groups.ResultsThe results indicate that an increase in yearly maximum reimbursement amount for outpatient visits could cause an increase in yearly total outpatient expenses for patients with type 2 diabetes mellitus. However, changes in outpatient reimbursement rates between 2010 and 2011 did not significantly affect the utilization of different types of health institution.ConclusionsThe reimbursement rates of village clinics should be substantially increased from the existing basis and the gap of reimbursement rates among different institutions should be further widened. It is also important for village clinics to improve their services. Moreover, measures to improve the quality of care and scope of services at lower-level healthcare institutions, and promote the health service utilization of rural women should be considered.

Stakeholders' perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms.

BackgroundAdequate care for individuals living with chronic illnesses calls for a healthcare system redesign, moving from acute, disease-centered to patient-centered models. The aim of this study was to identify Belgian stakeholders’ perceptions on the strengths, weaknesses, opportunities and threats of the healthcare system for people with chronic diseases in Belgium.MethodsFour focus groups were held with stakeholders from the micro and meso level, in addition to two interviews with stakeholders who could not attend the focus group sessions. Data collection and the discussion were based on the Chronic Care model. Thematic analysis of the transcripts allowed for the identification of the strengths, weaknesses, opportunities and threats of the current health care system with focus on chronic care.ResultsInformants stressed the overall good quality of the acute health care system and the level of reimbursement of care as an important strength of the current system. In contrast, the lack of integration of care was identified as one of the biggest weaknesses of today’s health care system, along with the unclear definitions of the roles and functions of health professionals involved in care processes. Patient education to support self-management exists for patients with diabetes and/or terminal kidney failure but not for those living with other or multiple chronic conditions. The current overall fee-for-service system is a barrier to integrated care, as are the lack of incentives for integrated care. Attending multidisciplinary meetings, for example, is underfinanced to date. Finally, clinical information systems lack interoperability, which further impedes the information flow across settings and disciplines.ConclusionOur study’s methods allowed for the identification of problematic domains in the health system for people living with chronic conditions. These findings provided useful insights surrounding perceived priorities. This methodology may inspire other countries faced with the challenge of drafting reforms to tackle the issue of chronic care.

Current Status of Clinical Laboratory Reimbursement

1. Rick Panning, MBA, MLS(ASCP)CM[⇑][1] 1. Chair, ASCLS Government Affairs Committee , Director of Business Development for Shared Clinical Services, Fairview Health Services, Minneapolis, MN 1. Address for Correspondence: Rick Panning, MBA, MLS(ASCP)CM , 4894 Meadow Lane, Shoreview, MN 55126, 651-280-5909, panning4{at}comcast.net. 1. Define the basic difference between retrospective reimbursement and prospective payment as it applies to laboratory services. Describe the impact this has had on the laboratory. 2. Describe how ACA has specifically impacted laboratory reimbursement in at least two ways. 3. Identify current potential threats to laboratory reimbursement. Introduction In general, reimbursement for laboratory services in this country comes from two third-party payer sources - government and private sector. This third-party payment allows patients to access laboratory services from hospitals, physician offices, long-term care and other post acute providers and private laboratories. There are many components to this complex reimbursement system, including how and when tests are covered (coverage decisions), procedure and diagnosis codes (identifying what was actually ordered and performed) and payment methodologies. While levels of reimbursement are intended to reflect the value and the cost of the service being provided, over time the level of payment has been continually reduced to meet financial goals of the government or the healthcare system. Government payers primarily reflect Medicare on the federal level and Medicaid (Medical Assistance) on the state level. The Medicare program is the most influential reimbursement system since it often impacts state programs and private payer reimbursement policies and payment levels. All public payers and approximately 67% of private payers use Medicare's payment methodologies as the basis for their own and as tools for negotiating discounts with providers.1 In our current fiscal environment, with pressures on the federal budget and concerns about the long term viability of Medicare, we have seen a change in which the Medicare program is beginning to look at private payer reimbursement levels as an opportunity to reduce its financial responsibility for laboratory reimbursement. The steady reduction in payment levels from Medicare and other payers are resulting in a negative impact on… ABBREVIATIONS: ACA – Accountable Care Act; APC – Ambulatory Patient Classification; CAH – Critical Access Hospital; CLFS – Clinical Laboratory Fee Schedule; CMS – Centers for Medicare and Medicaid Services; CPI – Consumer Price Index; DRG – Diagnosis Related Group; FEHB – Federal Employee Health Benefits; IOM – Institute of Medicine; MolDX – Molecular Diagnostics; MS-DRG – Medical Severity Diagnosis Related Group; NLA – National Limitation Amount; OIG – Office of Inspector General; OPPS – Outpatient Prospective Payment System; PPS – Prospective Payment System; SGR – Sustainable Growth Rate. 1. Define the basic difference between retrospective reimbursement and prospective payment as it applies to laboratory services. Describe the impact this has had on the laboratory. 2. Describe how ACA has specifically impacted laboratory reimbursement in at least two ways. 3. Identify current potential threats to laboratory reimbursement. [1]: #corresp-1

Reference pricing system in Portugal – Supply, demand, and the effect of reimbursement level

The reference pricing system (RPS) in Portugal was intended to control the growth of pharmaceutical expenditure. Our research evaluated whether this was achieved, and which variables are determinant. We considered a sample of significant homogeneous groups before and after RPS implementation. We applied a multivariate linear regression analysis by ordinary least squares. RPS was related to a decrease of −2.9 percentage points (P < 0.001) in average price, −2.8 percentage points (P < 0.001) in brands' prices, and −9.7 percentage points (P < 0.001) in the difference between the average price of brands and the reference price (RP). There was an increase of 12.6 percentage points (P < 0.05) in the demand ratio of generics versus brands, and a statistically significant decrease in the consumption of medicines with a public price higher than the RP. RPS was associated with an increase of 9.8 percentage points in the number of generics. For higher levels of reimbursement there was a statistically significant decrease in prices, related to the RPS. The RPS in Portugal has driven a decrease in the price of medicines and an increase in demand for medicines with the same price as the RP. However, the effect on expenditure was not achieved.

Policy Analysis: Medicare Alters Outpatient Hospital Audiology Rates for 2014

You have accessThe ASHA LeaderPolicy Analysis1 Jan 2014Policy Analysis: Medicare Alters Outpatient Hospital Audiology Rates for 2014 Mark Kander Mark Kander Google Scholar More articles by this author https://doi.org/10.1044/leader.PA2.19012014.np SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Medicare Alters Outpatient Hospital Audiology Rates for 2014 By Mark Kander Medicare reimbursement rates for several audiology hospital outpatient billing codes have increased substantially in 2014, according to the 2014 final rule for the hospital outpatient prospective payment system issued in late November 2013 (see chart below). Reimbursement levels for several individual vestibular tests increase by 13 percent; however, the rate for basic vestibular evaluation, CPT 92540 (Common Procedural Terminology,® American Medical Association), increases 4.8 percent. The fee for CPT92586, screening using auditory evoked potentials, increases 60 percent to $128, significantly surpassing the Medicare non-hospital rate and serving as a valuable fee reference used by other payers. The comprehensive hearing test (CPT 92557) incurs a rare decrease of 15.4 percent, but the rate remains more than twice as high as the Medicare non-hospital fee. The payment rate for cochlear implantation (including the device) increases by 1.4 percent, and the rate for osseointegrated implantation (with device) increases by 1.3 percent. Hospitals report that although the cochlear device cost is covered in this rate, the complete surgical costs are not. The hospital outpatient prospective payment system determines rates by assigning CPT codes to ambulatory payment classifications. The codes in any given classification are comparable clinically and with respect to resource use, based substantially on national hospital cost records from two years prior. The 2014 rule changes the classification of several audiology-related procedures, resulting in substantial reimbursement increases or decreases for some of the re-assigned codes. The final rule for hospital outpatient services also consolidates some hospital outpatient physician office visits from 10 procedure codes to one—and a single payment level. The American Hospital Association has been critical of this decision, stating that this will result in payment levels well below the cost of treating complex patients. Although this regulation does not affect audiologists directly, ASHA is carefully watching this trend. Codes with an increase of at least 10 percent Codes with an increase of at least 10 percent Codes with an increase of at least 10 percent Codes with a decrease of at least 10 percent Codes with a decrease of at least 10 percent Author Notes Mark Kander is ASHA director of health care regulatory analysis. [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 19Issue 1January 2014 Get Permissions Add to your Mendeley library History Published in print: Jan 1, 2014 Metrics Current downloads: 61 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2014 American Speech-Language-Hearing AssociationLoading ...

Study participants incentives, compensation and reimbursement in resource-constrained settings.

IntroductionControversies still exists within the research fraternity on the form and level of incentives, compensation and reimbursement to study participants in resource-constrained settings. While most research activities contribute significantly to advancement of mankind, little has been considered in rewarding directly the research participants from resource-constrained areas.MethodsA study was conducted in Zimbabwe to investigate views and expectations of various stakeholders on study participation incentives, compensation and reimbursement issues. Data was collected using various methods including a survey of about 1,008 parents/guardians of school children participating in various immunological cohort studies and parasitology surveys. Community advisory boards (CABs) at 9 of the sites were also consulted. Further, information was gathered during discussions held at a basic research ethics training workshop. The workshop had 45 participants that including 40 seasoned Zimbabwean researchers and 5 international research collaborators.ResultsAbout 90% (907) of the study participants and guardians expected compensation of reasonable value, in view of the researchers' value and comparison to other sites regardless of economic status of the community. During discussion with researchers at a basic ethics training workshop, about 80% (32) believed that decisions on level of compensation should be determined by the local research ethics committees. While, the few international research collaborators were of the opinion that compensation should be in accordance with local guidelines, and incentives should be in line with funding. Both the CAB members and study participants expressed that there should be a clear distinction between study incentive and compensation accorded to individual and community expectations on benefits from studies. However, CABs expressed that their suggestions on incentives and compensation are often moderated by the regulatory authorities who cite fear of unknown concerns.ConclusionOverall, both personal and community benefits need to be considered colectively in future studies to be conducted in resource-constrained communities. There is projected fear that recruitment in future may be a challenge, now that almost every community, has somehow been reached and participated in some form of studies. A major concern on reimbursement, compensation or incentives should be internationally pegged regardless of different economic status of the individuals or communities where the study is to be conducted.

Healthcare Employersʼ Policies on Nurse Education

The 2010 recommendation that the proportion of registered nurses with BSN (bachelor of science in nursing) degrees in the nursing workforce should increase from the current 40% to 80% by the year 2020 has shifted the focus on nurses educational progression from state legislatures-where changes in entry-level requirements were debated for decades-to the executive suites of large healthcare providers. The recommendation, contained in the report titled The Future of Nursing: Leading Change, Advancing Health, by the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine, suggests that human resources policies for nurses have the potential to double the rates of college degree completions (IOM, 2010). We surveyed 447 nurse executives in hospitals, nurse-led clinics, and home and hospice companies to explore the current practices of healthcare employers with regard to this recommendation. Almost 80% of respondents reported that their institution either preferred or required newly hired nurses to have a bachelor's degree, and 94% of the facilities offered some level of tuition reimbursement. Only 25%, however, required their nurses to earn a BSN or offered salary differentials on the basis of educational attainment (9%). We conclude that if employers are serious about wanting a more highly educated nurse workforce, they need to adopt requirements for degree completion and wage differentials in the coming years. The likelihood that such policies will be widely adopted, however, is dramatically affected by the dynamics of nursing supply and demand.

PHP126 - A Comparative Study of the Role of Disease Severity in Drug Reimbursement Decision Making in Belgium, France, the Netherlands and Sweden

Considerations beyond (cost-) effectiveness are increasingly important in reimbursement decision-making. We investigated the importance of disease severity relatively to other decision criteria in drug reimbursement decision-making in four European countries. The importance of disease severity and its operationalization was assessed in Belgium, France, The Netherlands and Sweden. We investigated scientific literature, policy documents, reimbursement reports, and conducted three interviews in each country (four in The Netherlands) with policymakers involved in drug reimbursement. All interviewees acknowledged that disease severity is, especially in case of high severity, an important criterion while considering a drug’s (cost-) effectiveness. However, its relative importance compared to other decision criteria remains implicit in the decision-making process. Although rarity of the disease is not a criterion as such, interviewees indicated difficulties in separating rarity from severity and the availability of alternative treatments. Only Belgium and France explicitly show societal willingness to pay by using reimbursement levels depending on the severity of the disease. In Sweden, ‘need and solidarity’ is one of the three prioritizing principles. The Netherlands is the only country that quantitatively operationalized disease severity using the proportional shortfall method and suggesting a cost-effectiveness threshold range depending on disease severity (which was never formalised by the minister). Although interviewees acknowledged that quantitative information, besides a qualitative description of the disease, may provide additional decision information, none of them considered such information to be of decisive importance. Disease severity is, especially in case of high severity, an important decision criterion in all four countries. However, all countries seem to struggle in making its actual role explicit. The operationalization differs across countries. While Belgium and France are most explicit by using the severity of the disease in setting reimbursement levels, all countries could improve transparency of its actual importance relatively to other decision criteria.

PHP73 - The Impact of the Blind Bid Procedure in Hungary

The modified reference price procedure, which was introduced in October 2011, caused significant savings in the Health Insurance Fund’s Pharmaceutical budget. In our analysis we aim to give an insight into the effects of this measure on the drug consumption and on the sales of the pharmaceutical companies as well as measure the generated savings and losses on the side of the industry. In the course of the analysis we examine the change in the demand of the related drugs and in their composition, from the aspect of industry, financer and patients. We explore which are the price strategies of the companies and are they managed to increase the sales or decrease the losses with them. The proper knowledge of the effects of blind bid will support the decision making of the concerned market actors as well as the further rulemaking. A retrospective data analysis was conducted on the official NHIFA (national Health Insurance Fund) monthly data-base between October 2011 and March 2013. In the blind bid procedure 90 companies, 169 active substances and more than 2100 product were involved. The relevant products market share is almost 30% of the total Hungarian Pharmaceutical budget, which is almost 1 billion € annually. As we found, the blind bid process has a significant saving effect for the financer. The cumulative savings on the 18 months period reached 113 millions € for the financer. It means 24% reduction on the average reimbursement level, whilst the average manufacturer price decreased 16% and a minimal 3% savings was realized on the co-payment side. Huge savings were realized with this new reference pricing method, where the financer realized the most of the savings.

Sleeping money: investigating the huge surpluses of social health insurance in China

The spreading of social health insurance (SHI) worldwide poses challenges for fledging public administrators. Inefficiency, misuse and even corruption threaten the stewardship of those newly established health funds. This article examines a tricky situation faced by China's largest SHI program: the basic health insurance (BHI) scheme for urban employees. BHI accumulated a 406 billion yuan surplus by 2009, although the reimbursement level was still low. Using a provincial level panel database, we find that the huge BHI surpluses are related to the (temporarily) decreasing dependency ratio, the steady growth of average wages, the extension of BHI coverage, and progress in social insurance agency building. The financial situations of local governments and risk pooling level also matter. Besides, medical savings accounts result in about one third of BHI surpluses. Although these findings are not causal, lessons drawn from this study can help to improve the governance and performance of SHI programs in developing countries.

Performance-Based Risk-Sharing Arrangements—Good Practices for Design, Implementation, and Evaluation: Report of the ISPOR Good Practices for Performance-Based Risk-Sharing Arrangements Task Force

There is a significant and growing interest among both payers and producers of medical products for agreements that involve a “pay-for-performance” or “risk-sharing” element. These payment schemes—called “performance-based risk-sharing arrangements” (PBRSAs)—involve a plan by which the performance of the product is tracked in a defined patient population over a specified period of time and the amount or level of reimbursement is based on the health and cost outcomes achieved. There has always been considerable uncertainty at product launch about the ultimate real-world clinical and economic performance of new products, but this appears to have increased in recent years. PBRSAs represent one mechanism for reducing this uncertainty through greater investment in evidence collection while a technology is used within a health care system. The objective of this Task Force report was to set out the standards that should be applied to “good practices”—both research and operational—in the use of a PBRSA, encompassing questions around the desirability, design, implementation, and evaluation of such an arrangement. This report provides practical recommendations for the development and application of state-of-the-art methods to be used when considering, using, or reviewing PBRSAs. Key findings and recommendations include the following. Additional evidence collection is costly, and there are numerous barriers to establishing viable and cost-effective PBRSAs: negotiation, monitoring, and evaluation costs can be substantial. For good research practice in PBRSAs, it is critical to match the appropriate study and research design to the uncertainties being addressed. Good governance processes are also essential. The information generated as part of PBRSAs has public good aspects, bringing ethical and professional obligations, which need to be considered from a policy perspective. The societal desirability of a particular PBRSA is fundamentally an issue as to whether the cost of additional data collection is justified by the benefits of improved resource allocation decisions afforded by the additional evidence generated and the accompanying reduction in uncertainty. The ex post evaluation of a PBRSA should, however, be a multidimensional exercise that assesses many aspects, including not only the impact on long-term cost-effectiveness and whether appropriate evidence was generated but also process indicators, such as whether and how the evidence was used in coverage or reimbursement decisions, whether budget and time were appropriate, and whether the governance arrangements worked well. There is an important gap in the literature of structured ex post evaluation of PBRSAs. As an innovation in and of themselves, PBRSAs should also be evaluated from a long-run societal perspective in terms of their impact on dynamic efficiency (eliciting the optimal amount of innovation).

An Argument for the Integration of Healthcare Management With Public Health Practice

As the U.S. healthcare system anticipates the requirements of legislated healthcare reform, front and center is the challenge of improving the U.S. healthcare value equation--the need to improve the value received for the health dollar spent. As is often the case, the psychology of change is at play here, whereby humans turn to what they know best as a response. As many health system leaders face the uncharted waters of U.S. reform and related downturns service utilization, pressured reimbursement levels, and restrictive access to markets, managers' responses often return to the familiar calls to action: * Enhance operating efficiencies * Reduce case costs * Implement more standardized clinical protocols and evidence-based best practices * Add provider-side integration (hospitals and physicians) * Step up marketing to improve penetration of historically profitable clinical markets (e.g., cardiovascular, orthopedics). While such responses are important and helpful, the missing factors this set of solutions may be time-tested principles of public health practice, which leads to the central thesis of the argument presented here: the need for U.S. healthcare systems to adopt useful principles and models of public health practice as new core competencies for health system management. IF YES, WHY NOW? Historically, healthcare administration has largely existed to manage the business of illness delivery, principally one patient at a time. Public health practice, on the other hand, has sought to protect and manage the well-being of populations, with a focus on such basic services as clean water, safe food, disease surveillance, disease prevention, and the epidemiology of various factors and environmental conditions. To be sure, these disciplines have been necessary and complementary to healthcare delivery, especially when disease affects the individual and the population at the same time under such conditions as epidemics. Now, however, a constellation of market and policy factors and conditions has created a need for the integration of complementary disciplines through the adoption of useful principles of public health practice by healthcare providers (and health systems) to enhance the U.S. health services delivery value equation. What arguments can be made for integration at this time? * An undeniably unaffordable U.S. health cost inflation rate * Rankings for U.S. healthcare worldwide outcome measures that land at the 30th position or lower among developed countries (Robert Wood Johnson Foundation, 2009) * An economic model that rewards doing more regardless of outcomes * A consumer who is virtually blind to real costs and quality * A clinical education and delivery model that recognizes the next physician involved with any patient as the captain of the ship, whose mandate is to do all possible at the moment of care on the basis of an interpretation of the presenting clinical facts and circumstances as encountered. Enter the demands for the enhanced value equation--demands that do, and should, fundamentally transmogrify our existing approach to health services organization and care delivery: 1. The acceleration of consolidation and integration on the provider side of the field (hospitals and hospital systems with physicians and other components of the delivery system) 2. The consolidation and transformation of the payer side (the insurers of commercial and governmental healthcare) toward seeking to transfer financial risk for covered populations to the provider side 3. Large, sophisticated health systems seeking to lock in defined populations through the assumption of financial risk, which will carry with it the assumption of the health risk of populations under contract 4. A need to engender the customer and brand loyalty of populations that will likely remain free to move from health system to health system (Zismer, 2012) So, how do principles and models of public health practice factor into the future picture as painted, and what is the likelihood that the health value equation can be enhanced? …

Is the level of patient co-payment for medicines associated with refill adherence in Sweden?

In the Swedish reimbursement scheme, the co-payment is based on the price of the product and decreases in a stepwise manner as the total accumulated co-payment increases. The aim of this study was to analyse how refill adherence in Sweden varies according to patient's co-payment level for medicines, with antiepileptic drug (AED) use as an example. Prevalent AED users aged 18-85 years who purchased an AED between 1 January and 30 June 2007 were identified in the Swedish Prescribed Drug Register and followed for a maximum of 2 years. Patient time was categorized based on patient's accumulated co-payment for all drugs per reimbursement period. The continuous measure of medication acquisition (CMA) was used to estimate refill adherence in relation to the patients' co-payment level. Associations between patients' co-payment for all medicines and refill adherence were assessed with multilevel mixed-effects linear regression, accounting for clustering within patients. The study population included 2210 patients (mean age: 56 years; 54% men). CMA for AED was 91% for patients where the co-payment corresponded to 100% of the price. Compared with these patients, refill adherence for AED was 2-4% higher (P < 0.001) for patients with reduced co-payment (co-payment of ≤50% of the price). Higher age, higher income and fenytoin use were also associated with a higher refill adherence for AED. Using AED as an example, a higher level of reimbursement was associated with a higher refill adherence compared with full co-payment in Sweden.

WE‐G‐137‐01: Medical Physics Economics

This presentation will review the aspects of medical physics economics and reimbursement that are relevant to the practicing clinical medical physicist. Covered topics will include:CPT© code development, valuation and useMedicare payment systems: Hospital Outpatient Prospective Payment System, Medicare Physician Fee Schedule and Ambulatory Surgical CentersGeneral coding and billing practicesUpcoming changes in reimbursementSources of informationAAPM economic activitiesKnowledge of these topics is essential to the practicing physicist to ensure that his/her work is recognized and billed for correctly. The presentation will not be a comprehensive billing seminar as coverage policies vary with location. However, general guidelines will be reviewed and sources of authoritative billing information will be included.Learning Objectives:1. Understand the three primary Medicare reimbursement systems, how they differ in coverage and in the way they determine reimbursement levels.2. Understand how CPT© codes are utilized to report billable work.3. Understand where to find authoritative billing and coding information.

Pediatric access to dermatologists: Medicaid versus private insurance

There is disparity in access to outpatient care for Medicaid beneficiaries. This inequity disproportionately impacts children. Access for children with skin disease may be especially limited. We sought to compare access to dermatologists for new pediatric patients insured by Medicaid versus a private plan. We surveyed 13 metropolitan markets by conducting secret-shopper scripted telephone calls to dermatology providers listed by Medicaid health plans. Paired calls, differing by insurance type, were made to each office on the same day, portraying a parent requesting a new appointment for a child with eczema. We called the offices of 723 Medicaid-listed providers. Final analysis included 471 dermatologists practicing general dermatology. Of these, an average of 44% refused a new Medicaid-insured pediatric patient. The average wait time for an appointment did not significantly vary between insurance types. Assuming that dermatologists not listed as Medicaid providers do not see Medicaid-insured children, our data indicate that pediatric Medicaid acceptance rates ranged from 6% to 64% by market, with an overall market size-weighted average acceptance rate of 19%. Relative reimbursement levels for Medicaid-insured patients did not correlate with acceptance rates. Although the most current health plan directories were used to create calling lists, these are dynamic. The sample sizes of confirmed appointments were in part limited by a lack of referral letters and/or health plan identification numbers. Only confirmed appointments were used to calculate average wait times. Access to dermatologists is limited for Medicaid-insured children with eczema.

A Good Doctor Can Give Bad Advice on Antipsychotics

A Good Doctor Can Give Bad Advice on Antipsychotics

Acute care surgery

Concern over lack of resident interest caused by the nonoperative nature and compromised lifestyle associated with a career as a "trauma surgeon" has led to the emergence of a new acute care surgery (ACS) specialty. This study examined the opinions of current general surgical residents about training and careers in this new field. A 36-item online anonymous survey regarding ACS was sent to the program directors of 55 randomly selected general surgery (GS) training programs for distribution to their categorical residents. The national sample consisted of 1,515 PGY 1 to 5 trainees. Response rate was 45%. More than 90% of residents had an appropriate understanding of the components of ACS as generally described (trauma, surgical critical care, and emergency GS). Nearly half (46%) of all respondents have considered ACS as a career. Overall, ACS ranked as the second most appealing career ahead of surgical critical care and trauma but behind GS. Most residents believed that ACS offers better or equivalent case complexity (88%), scope of practice (84%), case volume (75%), and level of reimbursement (69%) compared with GS alone. Respondents who answered ACS had a better scope of practice (61% vs. 36%), lifestyle as an attending surgeon (77% vs. 34%), or level of reimbursement (83% vs. 38%) compared with GS were twice as likely (p < 0.0001) to have considered ACS as a career. Overall, 40% of the residents believed that ACS offers a worse lifestyle in comparison with GS. These results suggest that there is notable interest in the emerging specialty of ACS. The level of resident interest in ACS as a fellowship and career may be increased by marketing those aspects of practice, which are viewed positively and addressing negative perceptions related to lifestyle. It may be appealing to add an elective GS component to certain ACS practice options.

The American Academy of Pediatrics and Quality Improvement

From the American Academy of Pediatrics, Elk Grove Village, Ill The views expressed in this report are those of the authors and do not necessarily represent those of the USDepartment of Health andHuman Services, the Agency for Healthcare Research and Quality or the American Board of Pediatrics Foundation. The authors declare that they have no conflict of interest. Publication of this article was supported by the Agency for HealthcareResearch andQuality and the American Board of Pediatrics Foundation. Address correspondence to ThomasK.McInerny,MD, FAAP, Department of Pediatrics, Children’s Hospital at Strong, 601ElmwoodAve, Box 777, Rochester, NY 14642 (e-mail: Thomas_McInerny@urmc.rochester.edu).